In the Journals

Transgender, gender nonconforming teens have diminished perceptions of health

Nic Rider

Teenagers who identify as transgender and gender nonconforming are more likely to report poorer physical and mental health than those who identify as cisgender, with less use of preventive health care measures, according to findings published in Pediatrics.

Additionally, perceptions of health were varied based on perceived gender expression of these students, with the largest representation of students reporting a gender perception of equally masculine and feminine.

“Some of our previous research indicates that, when compared to cisgender youth, [transgender and gender nonconforming (TGNC)] adolescents report experiencing higher rates of bullying and subsequently higher rates of emotional distress and substance use following from these incidents,” Nic Rider, PhD, from the Program in Human Sexuality in the department of family medicine and community health at the University of Minnesota, Minneapolis, told Infectious Diseases in Children.

These health outcomes may also be a result of negative experiences such as discrimination and other interactions that do not affirm their gender identities and expressions, which other studies indicate does happen in health care settings,” Rider continued.

To assess health care use among adolescents who are TGNC, as well as their mental and physical health status compared with cisgender adolescents, who identify with the sex they were born with, the researchers conducted an analysis that examined data collected in the 2016 Minnesota Student Survey.

Participants included teenagers between grades nine and 11 who reported gender expression, four different measures of health status and their use of health care in three areas. Rider and colleagues conducted this analysis by using chi-squares and multiple interpretations of covariance tests, which controlled for covariates for each demographic.

Of the 80,929 students included in the survey, 2.7% identified as TGNC and 97.3% identified as cisgender. The researchers observed that TGNC adolescents were more likely to have been assigned female at birth, of color or given free or reduced-price lunches compared with cisgender students. Rider and colleagues did not observe a difference in identity based on physical location (metropolitan vs. nonmetropolitan).

When assessing health status, 62.1% of TGNC youth reported a health status other than ‘very good’ or ‘excellent.’ The researchers noted that this rate was nearly double that of cisgender adolescents (33.1%; P < .001). Additionally, 59.3% of TGNC adolescents reported long-term mental health concerns, compared with 17.4% of cisgender teenagers (P < .001), and 51.5% of TGNC reported being absent from school for at least 1 day within the past month (cisgender = 42.6%). Despite these health concerns, TGNC youth used preventive medical and dental health care and more frequently visited the school nurse.

Regarding perceived gender expression, adolescents who were equally feminine and masculine encompassed the largest group of TGNC teenagers (assigned male sex = 29.3%; assigned female sex = 41.2%). The effect of perceived gender on health status was significant for students who identified as TGNC and were assigned male sex at birth (P < .001). This difference was statistically significant for at least two groups regarding general health and long-term mental health concerns.

For those assigned male sex at birth, poor general health was most frequently reported by those who perceived themselves as equally masculine or feminine (49.2%) or somewhat masculine (57.5%). These rates were high compared with those who identified as very masculine (32.1%). Those who identified as anything other than very masculine were more likely to have long-term mental health concerns (range = 40.7%-45.7%).

Those who were assigned female sex at birth were significantly more likely to have general health concerns if they perceived themselves as somewhat feminine (69.5%), equally feminine and masculine (70.4%) or somewhat masculine (71.7%). More than half of teenagers assigned female sex at birth who perceived themselves as very feminine reported poor health (54.0%). Similar to those assigned male sex at birth, those assigned female sex with any gender expression other than very feminine were more likely to have long-term mental health concerns (range = 68.1%-76.7%).

“When health care providers do have the opportunity to work with TGNC adolescents, it is important to ask them about these health risks as well as barriers they experience in terms of accessing, utilizing and receiving competent and quality care,” Rider said. “It is especially important for health care providers to also identify and refer to appropriate follow-up care when necessary. These are some of the ways health care providers can bolster wellness within this community.” – by Katherine Bortz

Disclosure: The authors report no relevant financial disclosures.

Nic Rider

Teenagers who identify as transgender and gender nonconforming are more likely to report poorer physical and mental health than those who identify as cisgender, with less use of preventive health care measures, according to findings published in Pediatrics.

Additionally, perceptions of health were varied based on perceived gender expression of these students, with the largest representation of students reporting a gender perception of equally masculine and feminine.

“Some of our previous research indicates that, when compared to cisgender youth, [transgender and gender nonconforming (TGNC)] adolescents report experiencing higher rates of bullying and subsequently higher rates of emotional distress and substance use following from these incidents,” Nic Rider, PhD, from the Program in Human Sexuality in the department of family medicine and community health at the University of Minnesota, Minneapolis, told Infectious Diseases in Children.

These health outcomes may also be a result of negative experiences such as discrimination and other interactions that do not affirm their gender identities and expressions, which other studies indicate does happen in health care settings,” Rider continued.

To assess health care use among adolescents who are TGNC, as well as their mental and physical health status compared with cisgender adolescents, who identify with the sex they were born with, the researchers conducted an analysis that examined data collected in the 2016 Minnesota Student Survey.

Participants included teenagers between grades nine and 11 who reported gender expression, four different measures of health status and their use of health care in three areas. Rider and colleagues conducted this analysis by using chi-squares and multiple interpretations of covariance tests, which controlled for covariates for each demographic.

Of the 80,929 students included in the survey, 2.7% identified as TGNC and 97.3% identified as cisgender. The researchers observed that TGNC adolescents were more likely to have been assigned female at birth, of color or given free or reduced-price lunches compared with cisgender students. Rider and colleagues did not observe a difference in identity based on physical location (metropolitan vs. nonmetropolitan).

When assessing health status, 62.1% of TGNC youth reported a health status other than ‘very good’ or ‘excellent.’ The researchers noted that this rate was nearly double that of cisgender adolescents (33.1%; P < .001). Additionally, 59.3% of TGNC adolescents reported long-term mental health concerns, compared with 17.4% of cisgender teenagers (P < .001), and 51.5% of TGNC reported being absent from school for at least 1 day within the past month (cisgender = 42.6%). Despite these health concerns, TGNC youth used preventive medical and dental health care and more frequently visited the school nurse.

Regarding perceived gender expression, adolescents who were equally feminine and masculine encompassed the largest group of TGNC teenagers (assigned male sex = 29.3%; assigned female sex = 41.2%). The effect of perceived gender on health status was significant for students who identified as TGNC and were assigned male sex at birth (P < .001). This difference was statistically significant for at least two groups regarding general health and long-term mental health concerns.

For those assigned male sex at birth, poor general health was most frequently reported by those who perceived themselves as equally masculine or feminine (49.2%) or somewhat masculine (57.5%). These rates were high compared with those who identified as very masculine (32.1%). Those who identified as anything other than very masculine were more likely to have long-term mental health concerns (range = 40.7%-45.7%).

Those who were assigned female sex at birth were significantly more likely to have general health concerns if they perceived themselves as somewhat feminine (69.5%), equally feminine and masculine (70.4%) or somewhat masculine (71.7%). More than half of teenagers assigned female sex at birth who perceived themselves as very feminine reported poor health (54.0%). Similar to those assigned male sex at birth, those assigned female sex with any gender expression other than very feminine were more likely to have long-term mental health concerns (range = 68.1%-76.7%).

“When health care providers do have the opportunity to work with TGNC adolescents, it is important to ask them about these health risks as well as barriers they experience in terms of accessing, utilizing and receiving competent and quality care,” Rider said. “It is especially important for health care providers to also identify and refer to appropriate follow-up care when necessary. These are some of the ways health care providers can bolster wellness within this community.” – by Katherine Bortz

Disclosure: The authors report no relevant financial disclosures.